| NPI | 1306354576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0029954) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.435589) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2021-10-27 |